Orthopaedic manual therapy, McKenzie method or advice only for low back pain in working adults: a randomized controlled trial with one year follow-up.

OBJECTIVE To examine the effects of 2 manual therapy methods compared with one counselling session with a physiotherapist with "advice-only to stay active" for treating low back pain/leg pain and disability. DESIGN A randomized, controlled trial with a 1-year follow-up. SUBJECTS A total of 134 subjects with low back disorders. METHODS Participants with acute to chronic first or recurrent low back pain, excluding those with "red flag" criteria, were assigned randomly to one of the 3 intervention groups: an orthopaedic manual therapy group (n=45), a McKenzie method group (n=52), and an "advice only to be active" group (advice-only) (n=37). Data on leg and low back pain intensity and disability (Roland-Morris Disability questionnaire) were collected at baseline, and at 3-, 6-, and 12-month follow-up points. RESULTS At the 3-month follow-up point, significant improvements had occurred in all groups in leg and low back pain and in the disability index, but with no significant differences between the groups. At the 6-month follow-up, leg pain (-15 mm; 95% confidence interval (CI) -30 to -1), back pain (effect: -15 mm; -27 to -4), and disability index (-4 points; -7 to -1) improved (p < 0.05) more in the McKenzie method group than in the advice-only group. At the 1-year follow-up, the McKenzie method group had (p=0.028) a better disability index (-3 points; -6 to 0) than did the advice-only group. In the orthopaedic manual therapy group at the 6-month and 1-year follow-up visits, improvements in the pain and disability index were somewhat better than in the advice-only group (p=0.067 and 0.068, respectively). No differences emerged between the orthopaedic manual therapy and McKenzie method groups in pain- and disability-score changes at any follow-up. CONCLUSION The orthopaedic manual therapy and McKenzie methods seemed to be only marginally more effective than was one session of assessment and advice-only.